Citation Nr: 0103551
Decision Date: 02/06/01 Archive Date: 02/15/01
DOCKET NO. 98-03 656 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in
Indianapolis, Indiana
THE ISSUES
1. Entitlement to an increased disability rating for a
lumbar spine disability, currently rated as 40 percent
disabling.
2. Entitlement to an increased disability rating for
maxillary sinusitis/rhinitis, currently rated as 10 percent
disabling.
3. Entitlement to an increased disability rating for
migraine headaches, currently rated as 10 percent disabling.
4. Entitlement to a total disability evaluation based on
individual unemployability (TDIU) resulting from service-
connected disabilities.
REPRESENTATION
Appellant represented by: AMVETS
ATTORNEY FOR THE BOARD
Jonathan B. Kramer, Associate Counsel
INTRODUCTION
The veteran had active duty service from January 1966 to
January 1969, and from June 1971 to July 1988.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a July 1997 rating decision rendered
by the Department of Veterans Affairs (VA) Regional Office
(RO) in Indianapolis, Indiana.
The Board further observes that although the veteran
requested a personal hearing before the Board in February
1998, the Board received correspondence from the veteran and
his representative in July and August 2000 stating that he
had withdrawn his request for a Board hearing. Therefore,
the Board hearing was properly withdrawn upon request of the
veteran, as provided for under 38 C.F.R. §§ 20.702(e),
20.704(e) (2000).
As the veteran has applied for TDIU, the Board finds that the
record also raises the issue of a permanent and total
disability rating for pension purposes under 38 C.F.R.
§ 3.342. This issue is hereby referred to the RO for
appropriate action.
FINDINGS OF FACT
1. The veteran's lumbar spine disability is not shown to be
productive of symptoms consistent with pronounced
intervertebral disc syndrome, nor is it shown to be
productive of ankylosis or complete immobility of the lumbar
spine.
2. The veteran's symptoms of chronic maxillary sinusitis are
productive of chronic and non-incapacitating symptoms of
nasal obstruction, sinus tenderness and pain, and
intermittent watery eyes; however, there is no medical
evidence of three or more incapacitating episodes per year of
sinusitis requiring prolonged (lasting four to six weeks)
antibiotic treatment, or; more than six non-incapacitating
episodes per year of sinusitis characterized by headaches,
pain, and purulent discharge or crusting.
3. The veteran's rhinitis is essentially asymptomatic.
4. The veteran's service-connected migraine headaches are
not productive of more than one prostrating attack every two
months over the past several months.
5. The veteran's service-connected disabilities are a low
back disorder, rated 40 percent; maxillary sinusitis and
rhinitis, rated 10 percent; migraine headaches, rated 10
percent; a right index finger laceration, rated 10 percent;
hiatal hernia, rated 10 percent; and bilateral hearing loss,
rated zero percent; the combined service-connected rating is
60 percent.
6. The veteran has a 11th grade education with a GED diploma
and 1 year of college, and employment experience as a
laborer; he was last employed in June 1994.
7. The veteran is not precluded from substantially gainful
employment as a result of his service-connected disabilities.
CONCLUSIONS OF LAW
1. The schedular criteria for a disability rating in excess
of 40 percent for lumbar spine disability have not been met.
38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14,
4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5285, 5286, 5289,
5292, 5293 (2000).
2. The schedular criteria for a disability rating in excess
of 10 percent for maxillary sinusitis have not been met.
38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14,
4.96, 4.97, Diagnostic Code 6513 (2000).
3. The schedular criteria for a rating in excess of 10
percent for migraine headaches have not been met.
38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14,
4.124a, Diagnostic Code 8100 (2000).
4. The criteria for TDIU have not been met. 38 U.S.C.A.
§§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.340, 3.341,
4.15, 4.16, 4.19 (2000).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
During the pendency of the appellant's appeal but after the
case was forwarded to the Board, the Veterans Claims
Assistance of Act of 2000, Pub. L. No. 106-475, 114 Stat.
2096 (2000) (Act) became effective. This liberalizing
legislation is applicable to the appellant's claims. See
Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). It
essentially eliminates the requirement that a claimant submit
evidence of a well-grounded claim, and provides that VA will
assist a claimant in obtaining evidence necessary to
substantiate a claim but is not required to provide
assistance to a claimant if there is no reasonable
possibility that such assistance would aid in substantiating
the claim.
After examining the record, the Board is satisfied that all
relevant facts pertaining to the increased rating and TDIU
claims have been properly developed as various VA general
medical and X-ray examinations were afforded the veteran in
recent years. Thus, no further assistance to the veteran is
required in order to comply with the duty to assist as
mandated by the Act.
The veteran claims that he has suffered increases in the
severity of his service-connected disabilities. After noting
that the claims file includes the veteran's SMRs, VA
examination reports, treatment records, and radiology
reports, private medical records, and the veteran's written
statements, the Board finds that the record as it stands is
adequate to allow for equitable review of the veteran's
increased rating claims and that no further action is
necessary to meet the duty to assist the veteran under 38
U.S.C.A. § 5107(a).
Disability evaluations are determined by the application of
the Schedule For Rating Disabilities, which assigns ratings
based on the average impairment of earning capacity resulting
from a service-connected disability. 38 U.S.C.A. § 1155; 38
C.F.R. Part 4. Where there is a question as to which of two
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates
the criteria required for that rating. Otherwise, the lower
rating will be assigned. 38 C.F.R. § 4.7. In addition, the
evaluation of the same disability under various diagnoses,
and the evaluation of the same manifestations under different
diagnoses, are to be avoided. C.F.R. § 4.14.
In order to evaluate the level of disability and any changes
in condition, it is necessary to consider the complete
medical history of the veteran's condition. Schafrath v.
Derwinski, 1 Vet. App. 589, 594 (1991). However, where an
increase in the level of a service-connected disability is at
issue, the primary concern is the present level of
disability. Francisco v. Brown, 7 Vet. App. 55 (1994).
Pursuant to a January 1989 RO rating decision, the veteran
was initially service connected for a lumbar spine disability
(10 percent rating assigned), maxillary sinusitis/rhinitis
(noncompensable rating assigned), and headaches
(noncompensable rating assigned), effective August 1, 1988.
In accordance with a December 1989 rating decision, the RO
increased the veteran's rating for his lumbar spine
disability to 20 percent, effective August 10, 1989. In a
January 1996 rating decision, the RO increased the veteran's
lumbar spine disability to 40 percent, effective August 3,
1995, increased the veteran's disability rating for headaches
to 10 percent effective August 3, 1995, and increased the
veteran's disability rating for maxillary sinusitis/rhinitis
to 10 percent effective March 21, 1995. These latter
disability ratings have remained in effect ever since.
I. Lumbar Spine Disability
An October 1997 VA spine examination report notes the
veteran's complaints of severe and constant pain in the low
back, especially after physical activity. The veteran stated
that he does not work except for odd jobs, such as cutting
grass, although such work is difficult for him. The
veteran's range of motion was as follows: forward flexion to
20 degrees, at which point pain began; extension to 10
degrees, at which point pain began; lateral bending to 10
degrees, at which point pain began; and rotation to 10
degrees, at which point pain began. There was no significant
incoordination with range of motion studies, although there
was weakened movement and excess fatigability with movement
of the lumbar spine. The examiner opined that it would
become more difficult for the veteran to bend during flare-
ups, thus causing additional functional impairment. There
were no postural or fixed deformities, and the musculature of
the back was normal. Neurological testing revealed sciatica,
positive pain with leg raising to 10 degrees, and there was
tenderness to percussion of the lumbosacral area. A review
of the veteran's many radiology reports was recited. The
diagnoses included degenerative spondylosis with severe
spinal canal stenosis; spondylosis L5; and degenerative joint
disease of the lumbosacral spine.
An October 1997 VA general medical examination notes that
although the posture was normal, the veteran walked in a
manner that protected his back. The diagnoses included
degenerative spondylosis with severe spinal canal stenosis
and degenerative joint disease of the lumbosacral spine.
An October 1997 VA neurological examination notes the
veteran's complaints of a constant and achy pain in the back
with radiation down both legs. The neurological examination
was described as normal.
An October 1997 VA radiology report revealed spondylosis of
L5 and mild degenerative change of the lumbar spine.
A private October 1997 radiology report of the lumbar spine
revealed mild stenosis of the thecal canal at the L2-3 level,
and generalized central bulging at the L3-4 and L4-5 levels.
An April 1999 VA radiology report revealed the following: a
straightening of the lumbar lordosis, slight retrolisthesis
of L4 on L5; mild spondylolisthesis of L5 and S1, a widening
of the spinal canal at L5; bilateral pars defect; disc
degeneration at L3/4, L4/5, and L5/S1; diffuse disc bulge,
facet osteoarthritis, and mild central spinal stenosis at
L3/4; a central protrusion, diffuse disc bulge, impingement
of the nerve roots, facet osteoarthritis, and minimal spinal
stenosis at L4/5; and diffuse disc bulging and facet
osteoarthritis at L5/S1.
Private treatment records for the period March 1999 to June
1999 shows that the veteran was seen for pain and limited
range of motion affecting the low back.
The Board has also considered veteran's lay statements, in
which he contends he is entitled to a 60 percent disability
rating on the basis that his symptoms have worsened
considerably.
The veteran's lumbar spine disability is currently rated as
40 percent, which is the maximum evaluation allowed under the
criteria for rating limitation of motion of the lumbar spine.
38 C.F.R. § 4.71a, Diagnostic Code 5292.
However, a review of the file reveals that at the time
veteran was initially service-connected for a lumbar spine
disability pursuant to the January 1989 rating decision, he
was rated under 38 C.F.R. § 4.71a, Diagnostic Code 5293,
which provides the guidelines for rating intervertebral disc
syndrome. Under this regulation, severe intervertebral disc
syndrome, with recurring attacks and intermittent relief,
warrants a 40 percent evaluation. A 60 percent rating is the
maximum rating permitted for intervertebral disc syndrome,
and is warranted when symptoms are pronounced, with
persistent symptoms compatible with sciatic neuropathy with
characteristic pain and demonstrable muscle spasm, absent
ankle jerk, or other neurological findings appropriate to the
site of the diseased disc, and little intermittent relief.
After a review of the claims file, the Board finds that the
evidence of record does not support the veteran's claim for a
60 percent rating under Diagnostic Code 5293. While his
symptoms are sufficient to be evaluated as severe, they have
not been shown to be so persistent in degree or severity as
to support a finding that the intervertebral disc syndrome is
pronounced. For instance, although there is evidence of
sciatica and pain on motion and with leg raising, there is no
medical evidence of muscle spasm or an absent ankle jerk.
The Board finds that the evidence of record more nearly
approximates the criteria for severe disability and does not
support a conclusion that a disability rating in excess of 40
percent for his lumbar spine disability is warranted.
In regard to the veteran's flare-ups or exacerbations, the
Board acknowledges that where functional loss is alleged due
to pain on motion, the provisions of 38 C.F.R. §§ 4.40 and
4.45 must be considered in addition to the schedular
criteria. DeLuca v. Brown, 8 Vet. App. 202, 207-208 (1995).
Moreover, as the veteran appears to suffer from arthritis of
the lumbar spine, 38 C.F.R. § 4.59 must also be considered.
Although there is evidence of painful movement causing
instances of functional impairment, the 40 percent rating
takes into account all of the relevant clinical findings that
have been reported. A 50 percent rating is warranted for
unfavorable ankylosis. 38 C.F.R. § 4.71a, Code 5289.
However, the objective medical evidence simply does not show
that the veteran's back pain or associated symptoms of
weakness and fatigability that may arise result in functional
impairment of the lumbar spine to a degree that is the
equivalent of ankylosis or complete immobility of the lumbar
spine. As service connection is not in effect for a
vertebral fracture, Code 5285 is not for application.
For the foregoing reasons, the preponderance of the evidence
is against the veteran's claim of entitlement to a disability
rating in excess of 40 percent for a lumbar spine disability.
II. Maxillary Sinusitis/Rhinitis
VA treatment records dated in January and February 1997 show
the veteran was seen for chronic maxillary sinusitis that was
symptomatic of sinus pain and tenderness, and headaches. A
January 1997 VA radiology report of the paranasal sinuses
revealed a diagnosis of partial clouding of the frontal and
maxillary sinuses.
An October 1997 VA general medical examination revealed
diffuse tenderness over the veteran's sinuses; the diagnoses
included chronic sinusitis.
An October 1997 VA upper respiratory system examination
report includes a review of the veteran's medical records and
recites the veteran's complaints chronic sinusitis with sinus
pain, watery eyes, headaches, stuffy nose/difficulty
breathing, and dyspnea on physical exertion. Objectively,
the veteran had to breathe through his mouth due to nasal
obstruction, and the frontal and maxillary sinuses were
tender to palpation. The veteran indicated he was not taking
any medications at the time of the examination. The October
1997 X-rays of the sinuses, which revealed bilateral
maxillary sinusitis, right frontal sinusitis, and mild
deviation of the nasal septum, were reviewed by the examiner.
The diagnosis was chronic sinusitis and mild deviation of the
nasal septum.
The Board has also taken into account the veteran's lay
statements, in which he claims that his sinusitis has
increased in severity, justifying a disability rating in
excess of 10 percent.
The veteran's service-connected maxillary sinusitis is rated
under 38 C.F.R. § 4.97, Diagnostic Code 6513, which provides
that a 30 percent disability rating is for application when
there are three or more incapacitating episodes per year of
sinusitis requiring prolonged (lasting four to six weeks)
antibiotic treatment, or; more than six non-incapacitating
episodes per year of sinusitis characterized by headaches,
pain, and purulent discharge or crusting. A 10 percent
disability rating is for application when there are one or
two incapacitating episodes per year of sinusitis requiring
prolonged (lasting four to six weeks) antibiotic treatment,
or; three to six non-incapacitating episodes per year of
sinusitis characterized by headaches, pain, and purulent
discharge or crusting. This regulation further provides in a
note that an incapacitating episode of sinusitis means one
that requires bed rest and treatment by a physician.
After a review of the relevant medical evidence and the
applicable laws and regulations, the Board finds that a
disability rating in excess of 10 percent is not warranted.
The assignment of a 30 percent rating requires that the
veteran meet one of two alternative sets of symptoms: three
or more incapacitating episodes per year of sinusitis
requiring prolonged antibiotic treatment, or; more than six
non-incapacitating episodes per year of sinusitis
characterized by headaches, pain, and purulent discharge or
crusting. Although the medical evidence of record shows that
the veteran underwent prolonged antibiotic treatment for his
sinusitis in 1995 and the first half of 1996, those records
do not show that his sinusitis was incapacitating, and there
is no evidence to show the veteran had antibiotic treatment
before 1995 or after 1996. In any case, it appears that his
more severe symptomatology and the need for antibiotic
treatment in 1995 and 1996 has not carried over into
subsequent years, and is not relevant to evaluating the
extent of his current disability. Moreover, although more
recent medical evidence shows that the veteran currently
suffers from chronic but non-incapacitating sinusitis
accompanied by sinus pain and tenderness, obstructed nasal
passages, and headaches (service connection and a 10 percent
rating are currently in effect for headaches), there is no
evidence of purulent discharge or crusting. In addition,
there is no medical evidence showing the veteran complained
of, or was treated for, sinusitis or any symptoms thereof
since October 1997. Thus, the medical evidence fails to show
that the veteran suffers from more than six non-
incapacitating episodes per year of sinusitis with the
necessary symptoms, or three or more incapacitating episodes
per year of sinusitis requiring prolonged antibiotic
treatment.
The Board also finds that the veteran's rhinitis is
essentially asymptomatic, a compensable disability rating is
not warranted.
In accordance with the foregoing reasons, the preponderance
of the evidence is against the veteran's claim of entitlement
to a disability rating in excess of 10 percent for maxillary
sinusitis/rhinitis.
III. Headaches
A December 1996 VA treatment record notes that the veteran
complained of a migraine headache of 15 days duration,
accompanied by nausea; the impression was a chronic and acute
headache, rule out migraine. A January 1997 VA treatment
record shows that the veteran was assessed with a migraine
headache, and in February 1997 he continued to complain of
headaches. A February 1997 radiology report of the brain was
negative.
An October 1997 VA general medical examination report notes
the veteran's complaints of headaches. The relevant
diagnosis was a migraine. A contemporaneous VA neurological
examination report recounts the veteran's complaints of
suffering from headaches for the prior twenty years, which
have been characterized by a throbbing, sometimes dull, achy
squeezing pain on his temporal region, at times severe enough
to cause nausea. The veteran also related that his headaches
could last up to three hours, sometimes causing an inability
to work. He has tried several different medications without
significant relief. The neurologic examination was normal.
The diagnosis was headaches.
An April 1999 private treatment record notes that the veteran
complained of a constant headache.
The Board has also considered veteran's lay statements, in
which he maintains that his migraine headaches have worsened
and are of such severity that a disability rating in excess
of 10 percent is warranted.
The veteran's disability is rated under 38 C.F.R. § 4.124a,
Diagnostic Code 8100, which provides the guidelines for
rating migraine headaches. Under this regulation, the
maximum disability rating is 50 percent, which is for
application when the headaches are manifested by very
frequent completely prostrating and prolonged attacks of
headaches productive of severe economic inadaptability. A 30
percent disability rating is for application when the
headaches are accompanied by characteristic prostrating
attacks occurring on an average of once a month over the last
several months. A 10 percent disability rating is for
application when the headaches are accompanied by
characteristic prostrating attacks averaging once in two
months over the last several months.
After review of the evidence of record in conjunction with
the applicable laws and regulations, the Board finds that a
disability rating in excess of 10 percent for the veteran's
migraine headaches is not warranted. Although the record
shows that the veteran suffers from chronic migraine
headaches that sometimes become acute, accompanied by nausea
and lasting up to three hours causing interference in his
ability to work, it is not shown that his episodes of acute
migraines result in prostrating attacks occurring an average
of once a month over the last several months. The veteran
complained of headaches in December 1996, January and
February 1997, October 1997, and April 1999. It therefore
appears that although his headaches may be chronic in nature,
they do not, on average, become prostrating more than once
every two months. Under the circumstances, the Board
believes the current 10 percent rating for not more than one
prostrating attack every two months over the past several
months most accurately reflects the current degree of
impairment associated with this disability. Therefore, the
preponderance of the evidence is against the veteran's claim.
In rendering this decision, the Board finds, as did the RO,
that the evidence of record does not present such "an
exceptional or unusual disability picture as to render
impractical the application of the regular rating schedule
standards." 38 C.F.R. § 3.321(b)(1). In this regard, the
Board has considered the history of the veteran's
disabilities, the current clinical manifestations, and the
effect this disability may have on the earning capacity of
the veteran under 38 C.F.R. §§ 4.1, 4.2, and finds that there
has been no showing by the veteran that his service-connected
has resulted in marked interference with his employment or
necessitated frequent periods of hospitalization. In the
absence of such factors, the Board finds that the criteria
for submission for assignment of an extraschedular rating
under 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v.
Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App.
218, 227 (1995).
As the preponderance of the evidence is against the veteran's
increased rating claims, the benefit-of-the-doubt doctrine is
inapplicable, and the claims must be denied. 38 U.S.C.A. §
5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
IV. TDIU
Total disability ratings for compensation based on individual
unemployability may be assigned where the schedular rating is
less than total, when it is found that the disabled person is
unable to secure or follow a substantially gainful occupation
as a result of a single service-connected disability ratable
at 60 percent or more, or as a result of two or more
disabilities, provided at least one disability is ratable at
40 percent or more, and there is sufficient additional
service-connected disability to bring the combined rating to
70 percent or more. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340,
3.34l, 4.16(a). Where these percentage requirements are not
met, entitlement to the benefits on an extraschedular basis
may be considered when the veteran is unable to secure and
follow a substantially gainful occupation by reason of
service- connected disabilities, and consideration is to be
given to the veteran's background including his employment
and educational history. 38 C.F.R. §§ 3.321(b), 4.16(b).
The veteran's combined service-connected disability rating is
60 percent. The veteran does not satisfy the percentage
rating standards for individual unemployability benefits,
although consideration to such benefits on an extraschedular
basis may be given. The issue is whether his service-
connected disabilities preclude him from engaging in
substantially gainful employment (i.e., work which is more
than marginal, that permits the individual to earn a "living
wage"). Moore v. Derwinski, 1 Vet. App. 356 (1991). For a
veteran to prevail on a claim for a TDIU rating, the record
must reflect some factor which takes this case outside the
norm. The sole fact that a claimant is unemployed or has
difficulty obtaining employment is not enough. A high rating
in itself is recognition that the impairment makes it
difficult to obtain or keep employment, but the ultimate
question is whether the veteran is capable of performing the
physical and mental acts required by employment, not whether
he can find employment. Van Hoose v. Brown, 4 Vet. App. 361
(1993).
The medical evidence of record reflects significant non-
service-connected disorders involving the cervical and
thoracic spine. Impairment from non-service-connected
disorders may not be considered in support of the claim for a
TDIU rating. 38 C.F.R. §§ 4.14, 4.19.
The veteran's education includes one year of college, and he
has post-service employment experience as a laborer. He last
worked in 1994; he asserts that he stopped work due to his
back condition.
The medical evidence shows minimal impairment from the
service-connected right index finger laceration (rated 10
percent), hiatal hernia (rated 10 percent), and bilateral
hearing loss (rated zero percent.) The veteran's rhinitis is
essentially asymptomatic. He maintains, in essence, that he
is unable to work due to his service-connected low back
disorder (rated 40 percent), sinusitis (rated 10 percent),
and migraine headaches (rated 10 percent).
As noted above, the veteran's lumbar spine disability is not
shown to be productive of symptoms consistent with pronounced
intervertebral disc syndrome. While he has significant
limitation of motion of the lumbar spine, there is no medical
evidence of ankylosis or complete immobility of the lumbar
spine. Moreover, while his symptoms are sufficient to be
evaluated as severe, they have not been shown to be so
persistent in degree or severity as to support a finding that
the intervertebral disc syndrome is pronounced. For example,
although there is evidence of sciatica and pain on motion and
with leg raising, there is no medical evidence of muscle
spasm or an absent ankle jerk. The veteran's symptoms of
chronic maxillary sinusitis are productive of chronic but
non-incapacitating symptoms of nasal obstruction, sinus
tenderness and pain, and intermittent watery eyes; there is
no medical evidence of recurrent incapacitating episodes of
sinusitis requiring prolonged treatment. The veteran's
migraine headaches are not productive of recurrent
prostrating attacks.
While the veteran's service-connected disabilities may limit
him from some forms of work, they do not prevent all
substantially gainful employment for which he is qualified by
reason of his education and work experience. The high
combined 60 percent compensation rating currently assigned
for his service-connected conditions is recognition that such
conditions would make it difficult to perform some forms of
work, yet the evidence fails to show that service-connected
conditions prevent him from performing the physical and
mental acts required for employment. The Board is cognizant
of the veteran's employment background and does not doubt
that jobs involving heavy manual labor may well be precluded
by his neck, mid-back and low back disabilities, but it is
again pertinent to note that, while the veteran's low back
disability is service-connected, his disabilities of the
cervical and thoracic spines are not. Moreover, he has one
year of college education and more importantly, there is no
medical opinion of record that supports the claim that he is
precluded from all forms of substantially gainful employment
for which he is qualified due solely to his service-connected
disabilities. There are no unusual factors which might make
his case different from similarly rated veterans. Van Hoose,
supra.
In sum, the veteran's service-connected disabilities do not
prevent gainful employment, and the criteria for a TDIU
rating are not met. As the preponderance of the evidence is
against the veteran's claim, the benefit-of-the-doubt rule is
inapplicable, and the claim for a TDIU rating must be denied.
38 U.S.C.A. § 5107(b); Gilbert, supra.
ORDER
Entitlement to a disability rating in excess of 40 percent
for a lumbar spine disability is denied.
Entitlement to a disability rating in excess of 10 percent
for maxillary sinusitis/rhinitis is denied.
Entitlement to a disability rating in excess of 10 percent
for migraine headaches is denied.
Entitlement to a total disability evaluation based on
individual unemployability is denied.
R. F. WILLIAMS
Member, Board of Veterans' Appeals